USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1961 > Part 43
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(Official Designation) (Date of Issue of Permit)
X
ving ( DEATH enter an one r each () and (c)
not mean of dying. It failure. e. It means mg or compli- caused
wij amy, m' rise to & se (a). 1. under- ase last.
sas contrib- th but mot De terminal ation given
0.1
Chapter 137, 14. requires a to print or h cause or c, death on ericates, and 3. Acts of egres Fhysi- o Int or type nd signaturc.
IRAN Labigil 127 196 -9145
PLACE OF DEATH
MR.301A 1 DORCHESTER DASS (City or Town)> CARNEy-Hospital
'RITIONS R CERTIFICATE (a) Residence. No. ( l'sual place of abode)
Length of stay: In place of death. years. months. .days.' In place of residence. . years.
12 hrs
St.
(Give maiden name of wife inefull)
1. 1 .. AL CETWIEN 01 SET AND DEATH
PARENTS
(PRINT OR TYPE SIGNATURE)
A TRUE COPY ATTEST: Charles it macke City Registrar
X PLACE OF DEATH
SUFFOLK
(County)
BOSTON
(City or Town)
Che Commonwealth of Passarhusrtis JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent. A. 09217
Registered No.
f(If death occurred in a hospital or institution,
St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
HARRIET
CLARSON
(First Name)
( Middle Name)
( Last Name)
( If deceased is a married, widowed or divorced woman, give also maiden name.)
42 Atlantic St.
St.
Winthrop, Mas3.
Length of stay: In place of death ..
.years .. ...
.. months.
5 days. In place of residence 30
years ............ months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
or Ditaowed
4I HEREBY
CERTIFY,
That We attended deceased from
Sept 26,
19 ...
19
61
01
to ...
Oct 1.
19.Q .... , death is said to
have occurred on the date stated above, at .
3:00 ....... m.
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
George J. Clarson
(Husband's name in full)
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Septicemia
Due To
(h)
Malignant lymphome-Hodgkin's
Due To
(c)
type
rterio sclorotio cardio
OTHER
SIGNIFICANT
vacoular .dicoase ..
20yrs
Was autopsy performed?
No
What test confirmed diagnosis?
clinical
5 Was disease or injury in any way related to occupation of deceased?
If so, specify
(Signed)
M. D
Charles L. Clc. M. D.
(PRINT OR TYPE SIGNATURE)
(Address)
· Dir., Mass. Gen'l. Hosp. Date Oct I, 19 67
6
HolyCross.Cemetery ..... Malden,Mass
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
October 4
19
61
7 NAME OF
FUNERAL DIRECTOR
Arthur J. OMaley
ADDRESS
Winthrop Mass
Received and filed
OCT 4 1961
Charl & Mación
(Registrar)
PARENTS
17 NAME OF
FATHER
Johnston McDermott
18 BIRTHPLACE OF
FATHER (City)
Bo.s.t.on
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Mary E. Calhoun
20 BIRTHPLACE OF
MOTHER (City)
Boston
(State or country)
Massachusetts
Sylvia McDermott
21
Informant
(Address)
42 Atlantic St., Winthrop Ma:
I HEREBY CERTIFY that a satisfactory standard certificate of death was/filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or other)
0%
10/2/10.
(Official Designation)
(Date of Issue of Permit)
1
TIONS
RTIFICATE
Ying CI DEATH enter lin one r each and (c)
mot meon of dying, rt failure, el It means tor compli- A caused
if any, rise to ase (a). under- last.
luis contrib- ich but mot terminal ciom given
hapter 137, 4. requires
1 al to print or h
cause or death on cricates, and r 3. Acts of og res Physi. int or type nd signature. . Dacton us only :X nk. 127 196 08145
5 mos
CONDITIONS
DETWEEN
ONCET AND
DEATH
11 IF STILLBORN, enter that fact here.
5 dys
AGE.
71 Years
Months
12
.Days
If under 24 hours
Hours.
Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Own Home
15 Social Security No.
16 BIRTHPLACE (City) Eact. Boston
(State or country)
Massachusetts
[ ( Was deceased a U. S. War Veteran.
(if so specify WAR)
(a) Residence. No.
( l'sual place of abode)
( If nonresident, give rity or town and State)
No.
Massachusetts General Hospital CARER MEMORIAL
OD: TOWN
R-301A
3 DATE OF
DEATH
Oct. 1. 1961
(Month)
(Day)
(Year)
Wf last saw h .. G.Alive on
Oct
1
A TRUE COPY ATTEST: Charles H. Mackie City Registrar
AR-301A at Washington Ave
R TIONS 2 ERTIFICATE
L'ing Of DEATH genter lin one r each 6 and (c)
os mat mean of dying, rt failure, Il meons for compli- uh caused
if any, rise la die (a). under- de last.
iAs contrib- deh but not terminal orion given C. 3
hapter 137, 14. requires ag to print or the cause or o death on etucates, and T
. Acts of egres Physi- o Int or type nd signature.
Doctor us only CKink. 127 196
0-145
X 1 PLACE OF DEATH
SUFFOLK
(County)
DOSTON
(City or Town)
JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
4.20 To be filed for burial permit with Board of Health or its Agent.
Registered No.
f(If death occurred in a hospital or institution, St. } give its NAME instead of street and number) PHYSICIAN - IMPORTANT No f ( Was deceased a U. S. War Veteran. {if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.) 34 Pleasant Street
St
Winthrop, Massachusetts
(If nonresident, give city or town and State)
Length of stay. In place of death ....... .... years
months.
10 days. In place of residence
5.0
years ...
... months.
.. days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
October
3
1961
(Month)
(Day)
(Year)
4
Sept 2
CERTIF
That theattended deceased
19
to ...
19
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
$12
AGE.6.
Years.
Months.
.... Days
If under 24 hours
....
.Hours .........
Minutes
313 Usual
Occupation :
Clerk
(Kind of work done during most of working life)
14 Industry
or Business :
Stock broker
15 Social Security No.
010-07- 1265
16 BIRTHPLACE (City)
(State or country)
Nova Scotia
17 NAME OF
FATHER
Dougal Mackinnon
S Was disease or injury in any way related to occupation of deceased? If so, specify
(Signed)
M. D
Chorlos . L .. Cl ="1, ..! ',D ...
(PRINT OR TYPE SIGNATURE)
(Address) Ass's Dir., Muss Goa'L Hasa. Date Oct 3 19 6]
6
Place of Burial or Cremation
Winthrop .... Cemetery. Winthrop (City or Town)
DATE OF BURIAL
October 6, 19
61
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop, Mass
Received and filed
Charles & Mac
(Registrar)
PARENTS
18 BIRTHPLACE OF
FATHER (City)
(State or country)
Nova Scotia
19 MAIDEN NAME
OF MOTHER
Margaret MacEachern
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Nova Scotia
21
Informant
Arthur J. O'Maley
(Address) 79 Atlantic St Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was fled with me BEFORE the burial, or transit permit was issued: Mcllamada
Signature of Agent of Board of Health or other)
3927
10/5/61
(Official Designation) (Date of Issue of Permit)
8 SEX
Female
9 COLOR
White
10 SINGLE
(write the word)
MARRIED
WIDOWED
of DIVORCEDSingle
W'elast saw
h.e.Lalive on
October 3
19 01, death is said to
have occurred on the date stated above, at
1:4.0.pn.
I. IL ... AL DETWEEN ORSET AND
DEATHS 3 dai
Due To
(b) Perforated Carcinoma of
Colon
Due To
(c)
OTHER
SIGNIFICANT
CONDITIONS
Metastatic Cancernoma
of :
.y.e.s.
Was autopsy performed?
What test confirmed diagnosis?
...... autopsy
0 day
No. MASSACHUSETTS GENERAL HOSPITAL
Margaret
2 FULL NAME
1
Isabelle .... Mckinnon
(First Name)
(Middle Name)
( Last Name)
(a) Residence. No.
( L'sual place of abode)
61'
october
m
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
Pronchopneumonia
(a)
A TRUE COPY ATTEST: Charles it. Mackie City Registrar
148
MR-301A -
TICTIONS IR CERTIFICATE
nlving · F DEATH a enter e jan one eor each . ) and (c)
dr not mean of dying, art failure. c. It means 1 or compli- Dich caused
us, if any, ve rise to use (a), ke under- use last.
dions contrib- ath but not the terminal "elition given
: Chapter 137, £954. requires lis to print or t: cause or f death on e tificates, and 148. Acts of nuires Physi- tprint or type 11 er signature.
-
1,1961
28145
PLACE OF DEATH
Worcester (County)
Worcester
(CWAdester Nursing 116 Houghton St. No.
Ho
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
221
To be filed for burial permit with Board of Health or its Agent. 2516
Registered No.
[(If death occurred in a hospital or institution, St. Į give its NAME instead of street and number)
2 FULL NAME
ANNA
( Hutchinson)
MAW
[(Was deceased a
( First Name)
(Middle Name)
(Last Name)
(if so specify WAR)
(If deceased is a married. widowed or divorced woman, give also maiden name.)
73 Chester St.
Ave.
St.
Winthrop, Mass.
(Usual place of abode)
Length of stay: In place of death.
years
months.
days. In place of residence
years ...
.. months.
... days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
female
9 COLOR
white
10 SINGLE
(write the word)
MARRIED
WIDOWEDWidowed
or DIVORCED
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John Maw
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
77
AGE
Years ...
Months ..........
Days
If under 24 hours
......
.. Hours .............. Minutes
13 Usual
Occupation :
Housewife
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
023-12-0767
16 BIRTHPLACE (City)
(State or country)
East.Boston, .... Mass.
17 NAME OF
FATHER
Jonathan Hutchinson
18 BIRTHPLACE OF
England
FATHER (City)
(State or country)
19 MAIDEN NAME
OF MOTHER
Ann Davis
20 BIRTHPLACE OF
England
.........
21 Informant Hr. John Naw 79 Walnut St. Saugus, Hass.
I HEREBY CERTIFY that a Satisfactory standard certificate of death pos ted with me BEFORE the buriat or transit perret was issued:
(Signature of Agent of Board of Health or other)
ACTING CO-COMMISSIONER
Oct 30,1961
(Official Designation)
(Date of Issue of Permit)
Charles M. Callehan ( 9.4)
1
PARENTS
6 Winthrop Cemetery Winthrop. Mal . MOTHER (City) (State or country)
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
No.v ....... 1, ..... 1961
19
7 NAME OF
FUNERAL
DIRECTOR Albert B. March 174 Winthrop St.
ADDRESS
winthrop
Received and filed NOV 1 1981 19
Robert J. O' Keefe
( Registrar)
61
(Month)
(Day)
(Year)
attended deceased from
That
Oct29
4 LHEREBY CERTIFY
Sept 17, 1961, to.
19.61
I last saw h&Calive on
Oct 27
1961, death is said to
have occurred on the date stated above, at
7 h& m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
(a)
Carcinoma OF Stomach
INTERVAL
BETWEEN
ONSET AND
DEATH
1yr
Due To
(b)
Carcinoma of liver secondary 4 mois
Due To
toa.
(c)
OTHER
SIGNIFICANT
CONDITIONS
Was autopsy performed?
NO
What test confirmed diagnosis?
Clinical Findings
5 Was disease or injury in any way related to occupation of deceased? \0 If so, specify
(Signed)
Joseph P. Hurley
Joseph P HURLEY
M. D
(PRINT OR TYPE SIGNATURE)
(Address) 590 MAIMI ST Date 10 29 1961
Y
PHYSICIAN - IMPORTANT
U. S. War Veteran.
(a) Residence. No.
(1f nonresident, give city or town and State)
50
3 DATE OF
DEATH
Oct.
29
1
6
NOV 1 41961 PM
1
City Clock
×
PLACE OF DEATH
Suffolk
(County)
Winthrop (City or Town)
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
[(If death occurred in a hospital or institution,
St. ¿ give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Israel
Shuman
(First Name) (Middle Name) (Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
54 Lewis Ave.
(Usual place of abode)
St
Winthrop .... Mass ...
Length of stay: In place of death ..
.. years .. ........ months.
6 .. days.
SE
In place of residence.
.years
months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
male
9 COLOR
White
10^SINGLE (write the word)
MARRIED
WIDOWED Married
or DIVORCED
10a If married, widowed, or divorced HUSBAND of
(Give maiden name of wife in full)
Posky
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE ...
74 Years.
Months ......
Days
If under 24 hours .. Hours ........... Minutes
13 Usual
Occupation :
Allvigner
(Kind of work done during most of working life)
14 Industry
or Business :
15 Social Security No.
16 BIRTHPLACE (City)
(State or country)
Russia
17 NAME OF
FATHER
Other Ahuman
18 BIRTHPLACE OF FATHER (City) (State or country)
Russia
19 MAIDEN NAME
OF MOTHER
C. B.L.
20 BIRTHPLACE OF
MOTHER (City)
(State or country)
Russia
21 Informant Gestude Ahuman
(Address) 54 Jewishve Wenthun
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued: <
(Signature of Agent of Board of Health or other)
11/7/61
(Official Designation)
(Date of Issue of Permity
28145
U R-301A 1
ST JCTIONS OR ALCERTIFICATE In iving
EF DEATH it enter rehan one «for each ), ›) and (c)
as not mean oc of dying, Heart failure, 1, c. It means ca: or compli- iich caused
itis, if any, ve rise to muse (a), he under- use last.
nd ons contrib- o ath but not tothe terminal Codition given C
e: Chapter 137, of 954. requires ici is to print or t: cause or f death on c tificates, and tel 48, Acts of nuires Physi- toprint or type wu er signature.
(Diferit Dowa() Brudt Annett 10
Place of Burial or Cremation (City or Town)
DATE OF BURIAL 2200
19
7 NAME OF
FUNERAL DIRECTOR
JoyFuneral bruel.x
ADDRESS Chelsea
Received and filed
NOV 3 1961
.19
(Registrar)
2,
1961
(Month)
(Day)
(Year)
4 I
HEREBY CERTIFY
Oct
19 56, to NOVEMBER 2, 1961
I last saw h .. f.Lalive on
Novi
2,, 1961, death is said to
have occurred on the date stated above, at
101,00 P.m.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
(a)
Nephritis, Chronic
2yrs,
Due To
(b)
Arteriosclerosis
2yrs
Due To (c)
OTHER
UREMIA
1yr
SIGNIFICANT
CONDITIONS Arterio sclerotic Heart Disease 1yV
Was autopsy performed?
NO
What test confirmed diagnosis?
Clinical
5 Was disease or injury in any way related to occupation of deceased? A If so, specify
(Signed) Please Liber Man, M. D CHARLES LIBERMAN, MID (PRINT OR TYPE SIGNATURE)
(Address) WINTHROP, MAS Date 11/2/1961
PARENTS
[(Was deceased a {U. S. War Veteran,
(if so specify WAR)
(If nonresident, give city or town and State)
3 DATE OF
DEATH
Thạt I attended deceased from
No. WinthropCommunity .... Hospital
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE. RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa - tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
PLACE OF DEATH
Suffolk (County
PETI
Winthrop. (City of Town)
No.
14 Edgehill Road
The Commonwealth of Massachusetts JOSEPH D. WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
Registered No.
[(If death occurred in a hospital or institution, St. { give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
2 FULL NAME
Frances.L ..... Coughlin
(First Name)
(Middle Name)
(Last Name)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
(a) Residence. No.
14 Edgehill Road
St
(If nonresident, give city or town and State)
Length of stay: In place of death.
years.
months ..
days. In place of residence 6.0
.. years,
months ...
.days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
8 SEX
9 COLOR
10 SINGLE
MARRIED
(write the word)
WIDOWED
or DIVOREPried
Female
White
10a If married, widowed, or divorced
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
John J. Coughlin
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE.7.6
Years.
Months ...
,Days
If under 24 hours
Hours ....
Minutes
13 Usual
Housewife
Occupation :
(Kind of work done during most of working life)
14 Industry
or Business :
Own .... Home
15 Social Security No.
16 BIRTHPLACE (City)
EastBoston
(State or country)
Massachuset
17 NAME OF
FATHER
Thomas Sheffield
18 BIRTHPLACE OF
FATHER (City)
East Boston.
(State or country)
Massachusetts
19 MAIDEN NAME
OF MOTHER
Catherine M. Lang
20 BIRTHPLACE OF
MOTHER (City)
East Boston
(State or country)
Massachusetts
21
Informant
John J. Coughlin
(Address)
14 Edgehill Road, Winthrop
I HEREBY CERTIFY that a satisfactory standard certificate of death was filed with me BEFORE the burial or transit permit was issued:
(Signature of Agent of Board of Health or. other) 1
11/6/61
(Official Designation)
(Date of Issue of Permit)
STUCTIONS OR AICERTIFICATE
Irgiving
E)F DEATH
t enter re han one Is for each ), b) and (c)
cis not mean ot of dying, s eart failure, a, tc. It means ca. or compli- tich caused
iti:s, if any, h ve rise to e zuse (a), g he under- tuse last.
na'ons contrib- o ath but not tithe terminal Codition given
e Chapter 137, of 954. requires iciis to print or cause or :8 f death on ctificates, and ter 48, Acts of r uires Physi- trint or type Wer signature.
6
Winthrop Cemetery
Winthrop.
Place of Burial or Cremation
(City or Town)
DATE OF BURIAL
November .....?..
19.61
7 NAME OF
FUNERAL DIRECTOR
Arthur J. O'Maley
ADDRESS Winthrop. Mass
Received and filed
November 6,
1961
(Registrar)
PARENTS
Was autopsy performed?
What test confirmed diagnosis? post-mortem judgement
5 Was disease or injury in any way related to occupation of deceased? no If so, specify
(Signed)
ed) arthur @ manay, M. D
Arthur C. Murray
(PRINT OR TYPE SIGNATURE)
(Winthrop Board of Health 11-3-61
-
Due To
(c)
Occlusion
sudden
OTHER
SIGNIFICANT
CONDITIONS
nonse
-
INTERVAL
BETWEEN
ONSET AND
DEATH
(a)
November 3 1961.
(Month)
(Day)
(Year)
4 I HEREBY CERTIFY,
That I attended deceased from
19
19
I last saw h ........ alive on
19 ..........
., death is said to
have occurred on the date stated above, at
11
P.m.
DEATH WAS CAUSED BY: IMMEDIATE CAUSE
Natural Causes
Due To
Presumably Coronary
(b)
no
₹ R-301A 1
-6(128145
[(Was deceased a
U. S. War Veteran,
[if so specify WAR)
(Usual place of abode)
3 DATE OF
DEATH
SPACE FOR ADDITIONAL INFORMATION
DATE OF ENTERING MILITARY SERVICE
DATE OF DISCHARGE RANK, RATING
ORGANIZATION AND OUTFIT
SERVICE NUMBER
1
6
NOV - 61961 PM
RULES OF PRACTICE
The fulfillment of the purpose of these laws calls for the observance of the following rules of practice :
(1) Attending physicians will certify to such deaths only as those of persons to whom they have given bedside care during a last illness from disease un- related to any form of injury.
(2) Board of Health physicians will certify to such deaths only as those of persons who, though disabled by recognized disease unrelated to any form of injury, have died without recent medical attendance or whose physician is absent from home when the certificate of death is needed.
(3) Medical Examiners will investigate and certify to all deaths supposably due to injury. These include not only deaths caused directly or indirectly by traumatism (including resulting septicemia), and by the action of chemical (drugs or poisons) thermal, or electrical agents, and deaths following abortion, but also deaths from disease resulting from injury or infection related to occu- pation, the sudden deaths of persons not disabled by recognized disease, and those of persons found dead.
Statement of Cause of Death .- Physicians: see explanatory instructions on face side of standard certificate of death.
Statement of Occupation .- Precise statement of occupation is very impor- tant, so that the relative healthfulness of various pursuits can be known. Make some entry in this section for every person aged 10 years or over. If the occupa- tion had been given up or changed, or if the deceased had retired from business, report the kind of work done during most of working life even if retired. Chil- dren not gainfully employed may be returned as at school or at home. For a woman whose only occupation was that of home housework, write housework. For a person engaged in domestic service for wages, however, designate the occupation by the appropriate terms, as housekeeper-private family, cook- hotel, etc. For a person who had no occupation whatever write none.
R-301A 1
CTIONS IR ERTIFICATE
ving F DEATH enter lan one or each ) and (c)
not mean of dying, art failure, . It means or compli- ch caused
, if any, gle rise to use (a), e under- use last.
fins contrib- ath but not o se terminal o. ition given
lapter 137, 1!1. requires into print or le cause or 0 death on r cates, and , Acts of gires Physi- Int or type disignature.
-62-925686
X PLACE OF DEATH
Suffolk
(County)
Winthrop
(City or Town)
Winthrop Community Hospital No.
Thr Commonwealth of Massachusetts JOSEPH D WARD SECRETARY OF THE COMMONWEALTH DIVISION OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH
To be filed for burial permit with Board of Health or its Agent.
001
[(If death occurred in a hospital or institution, St. } give its NAME instead of street and number)
PHYSICIAN - IMPORTANT
[(Was deceased a
{U. S. War Veteran,
no
[ if so specify WAR)
(If deceased is a married, widowed or divorced woman, give also maiden name.)
302 Maverick St.
East Boston, Mass.
St.
(If nonresident, give city or town and State)
Length of stay: In place of death ..
... years ...
. months
31.days. In place of residence.
.. years
months
days.
MEDICAL CERTIFICATE OF DEATH
PERSONAL AND STATISTICAL PARTICULARS
3 DATE OF
DEATH
November
4
1961
(Month)
(Day)
(Year)
4 I HEREBY
CERTIFY
That I attended deceased from
OCT 5
to ...
Nev 4
19.6.1
I last saw h .. . Malive on
Nov- 4, 1961, death is said to
have occurred on the date stated above, at 2 :15 Pm.
INTERVAL
BETWEEN
ONSET AND
DEATH
DEATH WAS CAUSED BY : IMMEDIATE CAUSE
CORONARY THROMBOSIS
(a)
· HYPERTENSIVE HEART DISEASE (b)
Due To (c)
OTHER
DIVERTICULITIS I PERFORATION, MO
SIGNIFICANT
AND HEMORRHAGE
CONDITIONS /INTESTINALOBSTRUCTION ZUKS
Was autopsy performed?
NO
What test confirmed diagnosis ?
CLINICA LOSURGICAL
:
5 Was disease or injury inany way related to occupation of deceased? NO If so, specify
(Signed)
Charles Jaleman
M. D.
369 HANOVER ST (PRINT OR TYPE SIGNATURE)
BOSTON
(Address)
Date .......
11/4 .19 61
6 Holy Cross Cemetery Malden
Place of Burial or Cremation
DATE OF BURIAL
Nov. 7,
(City or Town) 19.61
7 NAME OF
FUNERAL DIRECTOR
Vincent Rapino
ADDRESS 9 Chelsea St., East Boston, Mass.
Received and filed November 6, 1961
(Registrar)
8 SEX
male
9 COLOR
white
10 SINGLE
(write the word)
married
MARRIED
WIDOWED
or DIVORCED
10a If married, widowed, or divorced Giovannina DeVita
HUSBAND of
(Give maiden name of wife in full)
(or) WIFE of
(Husband's name in full)
11 IF STILLBORN, enter that fact here.
12
AGE86
Years ............
Months.
Days
If under 24 hours
Hours.
Minutes
13 Usual
Occupation :
Retired
14 Industry
or Business :
15 Social Security No.
011-01-3611
16 BIRTHPLACE (City)
(State or country)
Italy
17 NAME OF
FATHER
Ferdinando Marasca
18 BIRTHPLACE OF
FATHER (City)
(State or country)
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